Sometimes, it’s not so good to have principles

You read it often on messageboards throughout the ‘net: “But that still isn’t proof that (this vaccine, that GM food, this method) is safe! It’s all a huge experiment by the scientists, and we’re all guinea pigs!”. This despite the fact that the product or method under discussion (CIO, DTP vaccines, infant forumla or GM food) has been around for decades, millions have people have used it with no apparent harm or even much apparent benefit, or there are numerous studies which show no link whatsoever between the accused and the harm it’s alleged to have caused.

The argument these anti-whatevers (and it’s always an anti-something who raises this) are appealing to is called the precautionary principle. This very sensible prinicple – which states that the before adopting new concepts, their promoters have the burden of proving them safe beyond reasonable doubt – first was named in 1930s Germany, but has many precedents in phrases such as “better safe than sorry”, or in medicine, Primum non nocere (first, do no harm). In medicine in particular, one certainly can hark back to the Thalidomide disaster to illustrate what happens when scientific advances are inadequately tested in advance of their release to the general public.

But the notion that we must know every possible drawback to every change we make in the world in advance is not only unrealistic, it’s stifling. Nothing in this world is risk-free, and being the imperfect humans we are, there is no way we can possibly know everything about anything until we try it. This is not to say that rigorous testing of new products and new technologies (or even old ones, if suspicions are raised against them) is unnecessary. Nor is such testing a guarantee that shit will never happen – think about the Rotashield vaccine, Vioxx, or conversely, DES*, where side effects were not discovered until large numbers of people had used them, sometimes years after use. Nothing in life is guaranteed. However, unless we as a society are willing to assume some amount of risk in trying out new things, no progress will ever be made. And one must realize that failure to progress (not only in the obstetric sense) also has its risks. “Better the devil you know” is often a very unwise course of action.

Spiked has a wonderful article which enumerates the many scientific advances which would never have enhanced and saved so many lives, had we always heeded the precautionary principle. Among them are: Aspirin, antibiotics, contraceptive pills, open heart surgery, blood transfusions, the internal combustion engine, airplanes, vaccines, x-rays…just imagine how much poorer our quality of life would be without them. Imagine, also, what the world would be like if we rejected advances with the power to harm a small percentage of the population, modern transportation being the classic example, but also most lifesaving medical procedures and drugs.

It’s also important to remember that many of those who invoke the precautionary principle do so not out of concern for the masses, but for political purposes. They also tend to invoke it selectively – e.g, PCB’s in baby bottles are ‘proof’ that bottles are bad, but PCB’s in breastmilk are, mysteriously, not a cause for concern. Thimerosal in vaccines, despite the Institute of Medicine’s statement rejecting a connection with autism, is OMG A TOXIN WE’RE INJECTING INTO WIDDLE BABIES!, but the unregulated, non-FDA supervised potion their herbalist gave them? Just fine.

Keep in mind that the burden of proof is only to a reasonable standard. After all, it’s impossible to conclusively prove a negative (hence the wording, “evidence favors rejection of a causal relationship” in the IOM statement above). This opens the door for the naysayers to continue to demand more and more proof, bringing up more ond more empty objections to something they don’t like. At some point, the scientific community must put its foot down and get on with implementing the new (or continuing the old, if that’s what was objected to).

A great atricle on the subject illustrates this:

The absence of an effect can never be proved, in the way that I cannot prove that there are no fairies at the bottom of my garden. All I can say are two things: firstly, sustained observation over the past 20 years has revealed no evidence of their presence, and secondly the existence of fairies, in my garden or elsewhere, is very unlikely on a priori grounds. This is how science works – precisely in accord with the principles of Karl Popper that hypotheses cannot be proved, only refuted.

I suggest reading the whole thing.

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*On a personal note, my mother has 2 siblings who were severely affected by the DES my grandmother took during their pregnancies. I am certainly not making light of the possibility that deleterious effects may crop up only after many years of use. But such instances are exceedingly rare, and claiming that things that have been around for decades and have shown no such effects – aluminum and thimerosal in vaccines, infant formula, or GM food – are still in the experimental stage, is merely anti-science masquerading as the precautionary principle.

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10 Responses

  1. Wow Estherar you must be a youngster!!! My Mom took Des also when she was pregnant with me and then during the whole pregnancy with my sister.

    The internet is a very interesting place where anyone can argue anything no matter the basis in fact.

    I am getting a fair amount of parents who do not want their kids vaccinated and this is begining to worry me. Thanks for the article.

  2. Not such a youngster…I’ll be 38 on my next birthday. DES was banned a year later IIRC, but my grandmother has told me doctors were shunning it well before the big study on the subject came out. She didn’t take it for my youngest aunt (b. 1959), even though she’d had 2 m/c’s prior to conceiving her.

  3. These are excellent points very well presented. I attempt to make the same rational points to my patients’ parents when they refuse or are reluctant to immunize their children. It s a very difficult challenge in the short amount of time I have them in the office to get these points across – nearly impossible if they’re already fully a member of the “anti” camp. I fear we will need to see waves of disease hit these very same children before the pendulum begins to swing back around…

  4. I am oh-so-grateful to have a doctor who is adamant that my family and I NOT vaccinate or use antibiotics. I find it interesting that my kid has never had an ear infection, and only mild colds and fevers. The best thing a mother can do for her child’s health is not vaccinate, but breastfeed for at least a year or two.

  5. “I find it interesting that my kid has never had an ear infection, and only mild colds and fevers. ”

    My child has also never had an ear infection and only mild colds and fevers, and he’s both vaccinated and bottle-fed.

    “I am oh-so-grateful to have a doctor who is adamant that my family and I NOT vaccinate or use antibiotics.”

    I hope you don’t live anywhere near me, but I suspect you do since one of the biggest anti-vac crackpot docs lives near me. It scares me because I hate the thought of eventually sending my kid to school with kids who haven’t been vaccinated.

  6. I wouldn’t be so proud of myself if I picked a doctor who knows so little medicine s/he is adamant someone not vaccinate (antibiotics can and are overused, but certainly not always).

    I’ve already written about such a crackpot doctor (there’s more than one, unfortunately) and the utter stupidity of claiming that breastfeeding is a health measure superior to vaccines here. However, a brief perusal of kandylini’s blog shows she prefers to believe just about any cockamamie conspiracy theory rather than the truth.

  7. “It scares me because I hate the thought of eventually sending my kid to school with kids who haven’t been vaccinated.”

    If your kid is fully vaccinated, and they work so well, then you have nothing to worry about, right?

    As for my “crackpot” doctor (who helps keeps me well and healthy, thank you), I’ll take him over any of the lamestream M.D.s any day, many who hypocritically don’t get vaccinations themselves:

    “Rubella vaccine and susceptible hospital employees. Poor physician participation”

    http://jama.ama-assn.org/cgi/content/abstract/245/7/711

  8. “If your kid is fully vaccinated, and they work so well, then you have nothing to worry about, right?”

    That just demonstrates that you don’t understand how herd immunity works. Vaccines aren’t 100 percent effective in individuals, but once a certain percentage of the population is vaccinated (the percentage varies for different vaccines), diseases can’t take hold and the entire population is protected. But if the number of people who are vaccinated falls below that percentage, then disease can spread to individuals who didn’t develop immunity in response to the vaccine (not to mention those who are too sick or young to be given a vaccine).

    By not vaccinating your kid, you make it more likely that we as a community will slip below the threshold needed for herd immunity and you put my kid and everyone else’s at risk. This includes pregnant women whose babies can be exposed to rubella and suffer terrible birth defects as a result. So yeah, keep your kids away from mine.

  9. I understand, all right, but I’m not living in fear of these diseases. Thank goodness, I’ve been liberated from that. If you’re that worried about your kid getting them, YOU should keep her/him from every one else—it’s my right not to vaccinate (although I do keep my kid home from school at the slightest sign of a temperature or sore throat). I feel sorry for people like you who live in fear like that, and think that the magic shots will keep all the problems away.

    I’m listening to a snippet of a CBS interview with former NIH head Dr. Healy, who says that the government is “Too Quick To Dismiss Possible Link” between autism and vaccinations. I wonder what kind of spin all the Big Pharma apologists and shills will put on her words? Should be interesting.

    http://www.cbsnews.com/stories/2008/05/12/cbsnews_investigates/main4086809.shtml

  10. Well, I feel sorry for people who fear “pesticides”, vaccines, and who think rense.com, WND and Counterpunch are reliable sources of information. Just shows you can’t vaccinate against willful ignorance.

    As for doctors being lousy patients themselves (re the JAMA link), that’s not really news. Of course, as the article is 27 years old, it’s, really, really not news. That they didn’t get around to vaccinating themselves doesn’t mean they don’t vaccinate their children. Overwhelmingly, they do.

    Dr. Bernadine Healy, however, is off her rocker if she thinks her words (aided and abetted by the media) won’t make the public fear vaccines. Hasn’t she seen what Wakefield has wrought in the UK? Her misrepresentiation of what the IOM report said (the link is above) and of the animal studies done is irresponsible, to say the least. I really hope it was the reporter’s idea, and not hers, to tack on a .pdf file with the opinions of Dr. Marcel Kinsbourne – who’s been an anti-vax “expert witness”, much like Wakefield, for the better part of 2 decades. If we’re already talking about shills…

    I guess I’ll have to blog about the thimerosal issue sooner or later – and now I have a good idea how to do it.

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